The prevalence of chronic liver disease, cinliosis and decompensated portal hypertension is on the rise and represents and important public health problem. Liver transplantation provides a life sustaining alterative to death from end stage liver disease in those who are suitable. Although transplantation is feasible, its use is limited by organ availability. Of the people listed for liver transplantation, a considerable percentage are withdrawn from the liver transplant waiting list due to death or other morbidity. Given the high personal and financial cost of inappropriate listing, it is crucial to identify the factors that prognosticate a successful listing so that we can best allocate this limited resource. The proposed research will specifically address this issue using a retrospective cohort design. In a cohort of patients listed for cadaveric liver transplantation at the University of Pennsylvania we plan to describe the relationship between the Model for End Stage Liver Disease (MELD) score at listing and the outcomes of successful transplantation, list withdrawal or death. This will be accomplished through the following three inter related specific aims: Specific Aim 1: To describe the distribution of listing MELD scores amongst patients who were successfully listed for liver transplantation (transplanted) and those who were unsuccessfully listed (withdrawn or died) in a cohort of patients listed at The University of Pennsylvania between March 2002 and March 2006. Specific Aim 2: To determine if the MELD score at the time of listing for liver transplantation is associated with the outcome of successful transplant, patient death, or withdrawal from the transplant list. Specific Aim 3: To determine if the following clinical factors are associated with the outcome of successful transplant, patient death, or withdrawal from the transplant list: etiology of liver disease or having had a complication of portal hypertension prior to listing (hyponatremia, refractory ascites, spontaneous bacterial peritonitis, variceal hemorrhage, or encephalopathy of sufficient severity to require hospitalization). PUBLIC HEALTH RELEVANCE: The proposed research will provide the transplant community with crucial information. Knowledge of the characteristics of those who are unsuccessfully listed for liver transplantation would allow the possibility of an appropriate intervention such as the allocation of "exception points". Therefore, the identification of factors associated with waiting list withdrawal or death based on the listing MELD scores is of paramount importance to improve the excess of waitlist withdrawals and deaths.